1
Q
Pathology in Korsakoff’s
A
Hemorrhage + sclerosis in mammillary bodies, thalamic nuclei
Diffuse lesions in brainstem, cerebellum, limbic system
2
Q
CBT vs SSRI in generalized anxiety discord (effectiveness)
A
CTB is as effective as SSRI
3
Q
Rx of generalized anxiety
A
SSRI: paroxetine, escitalopram
SNRI: duloxetine, venlafaxine
4
Q
SSRI/SNRI vs Benzo vs Buspirobe for generalized anxiety
A
SSRI/SNRI more effective
5
Q
Defense mechanism in borderline personality
A
Splitting
6
Q
Alzheimer’s develops psychotic Sx (hallucinations / delusions)
A
Anti-psychotics
Risperidone
7
Q
Dx borderline personality
A
5/8:
- impulsive
- unstable relationships
- anger
- moody
- self-damage act
- can’t accept loss
- emptiness
- Boredom
8
Q
Cocaine intoxication Sx
A
Sympathetic (tachycardia, HTN, sweating, mydriasis)
+/- paranoia, psychosis
9
Q
Freud’s psychosexual development
A
- Oral phase:
0-18 mo
Stimulating mouth
Put anything in mouth - Anal phase:
18-36 mo
Pleasure in anal area
Control bowels - Phallic phase:
3-6 yr
Manipulation of genitals = 1ry source of pleasure. - Latency phase:
6- puberty
Connections to siblings, other children/adults - Genital phase:
> puberty
Relationship w/ opposite sex
Focused on genital area
10
Q
SE of haloperidol (48hr)
Rx?
A
Acute dystonia (torticollis)
It’s reversible EPS
Due to DA blockade at nigrostriatial
Rx with benzotropine
11
Q
Non-pharm Rx of insomnia
A
CBT to change believes, techniques, attention shift
12
Q
Amphetamine toxicity.
A
High DA + NE Hallucinations + delusions Paranoia Low appetite Activity w/ fatigue
13
Q
Conversion disorder population
A
Women
Histrionic personality
Sexual abuse
14
Q
Conversion disorder
A
Lack of concern regarding extreme decline in health.
Start suddenly after stress and ends suddenly
Not produced intentionally
15
Q
Population at risk of suicide
A
Elderly white men Single Unemployed , low income Mental illness Hx is abuse (sexual / physical) Hx of suicide thoughts FHx of suicide attempts
16
Q
Schizophrenia Schizophreniform Brief psychotic Schizoid personality Schiozoaffective
A
Schizophrenia = 6 mo Schizophreform = 1-6 mo Brief psychosis = < 1 mo Schizoaffective = psychosis + mood Schizoid PD = social withdrawal + no desire for relationships
17
Q
What’s discontinuation syndrome
A
After stopping SSRI Anxiety Influenza like Diarrhea + GI upset Insomnia, hyperarousal, lightheaded Vertigo, tremor, paresthesia
Lasts 7 days if stop SSRI after 6wk use.
18
Q
T/F: adults w/ ADHD impulsive + hyperactive as compared to kids
A
F
19
Q
Patient w/ anorexia
Sever dehydration + orthostatic hypotension + electrolyte imbalance?
- Would you search pt belongings? Why?
- Confirm she’s on Rx (contact professionals)
A
Yes!
Pts w/ eating disorders use laxative & diuretics
Facility must be informed to look for contraband.
20
Q
What’s Cognitive behavioral Rx?
A
Recognize + correct false self-beliefs
21
Q
What’s dialectical behavioral Rx?
A
Part of psychoanalysis/psychodynamic Rx that
Teach patient to analyze what leads up to a problem and identifies alternatives.
22
Q
Rx of Tourette’s
A
Anti-DA
Clonidine
Pimozide
23
Q
Types of delusions
- Nihilism
- Persecutory
- Grandeur
- Somatic
- Reference
A
- Nihilism = belief that aspects of life are meaningless or non-existing
E.g. Going to work is pointless b/c world is coming to an end
Or no one is real or arm is dead - Persecutory = others trying to harm him
- Grandeur =inflated sense of self
- Somatic = belief they have physical defect / disease.
My brain is melting - Reference = publicly known figures refer to him directly
24
Q
Percentage of smokers succeed in quitting
A
2-3%
25
T/F: genetics influence smoking persistence
T
26
What neuro system involved in reinforcing effect of nicotine
Mesolimbic
27
Percentage of population that experiment w/ smoking
55%
28
Hallmark of PCP (phenocyclidine) intoxication
Rotary nystagmus
29
Dx psychogenic seizure
Video-electroencephalograph VEEP
30
Cyclothoymia vs dysthymia
1. Cyclo: hypomania + mini depressive Sx for 2 years
| 2. Dysthymia: persistent mild depression
31
Hypnagogic vs hypnopompic hallucinations
Hypnoagogic: during sleeep
Hypnopompic: waking up
32
DOC delirium tremens
IV benzo (lorazepam
Use IM if > 65 YO
33
DOC panic disorder
SSRI
34
Involuntary admission?
1. Mental illness needs inpatient care
| 2. Danger to safety of patient or others.
35
Tourette associated w/?
OCD
| ADHD
36
What's sublimation
Transform negative emotion to positive action
37
T/F: imipramine has sigmoidal relationship b/w plasma level and response
T
38
T/F: nortriptyline has sigmoidal relationship b/w response and level
F = Curvilinear
39
MOA of MAOi
Stop degradation of monoamine transmitters and increase their levels
(Serotonin, norepi, dopamine)
40
MOA of typical antipsychotic
Risperdione + clozapine
Dopamine antagonist
41
SE of clozapine (typical antipsychotic)
Agranulocytosis
42
Risk for delirium in hospitalized pts
Vision / hearing impairment
43
Panic disorder associated w/
Depression
Anxiety
Agoraphobia
44
Asthma + social phobia
SSRI
45
When to stop antidepressants
3 month for Rx
| 6 mo after Rx maintenance
46
Bipolar on lithium develops hypothyroidism
Start replacement
| Don't stop lithium
47
Limbic system dz
Emotional disturbance
48
How Dx alcoholism
Ask about problem by alcohol
49
MAOi
Phenelzine
| Tranylcypromine
50
Serotonin syndrome Sx
Anxiety + agitation + restless
HTN, tachy, fever, sweat, shiver
Hyperreflexia, tremor, rigidity
51
Rx serotonin syndrome
Stop all med
+/- benzo if anxious and agitated
+/- Cyproheptadine
52
SSRI + tramadol = ?
SSRI + tramadol = serotonin syndrome
MAOi + tamadol = serotonin syndrome
53
Maintenance drugs for bipolar
Lithium
Lamotrigine
Aripiprqzole
Olanzapine
54
Child with ADHD has future risk of
Social withdrawal
Substance abuse
Accident proneness
Normal adult functioning
55
T/F: D/C SSRIs ass. w/ high rate of relapse
T
56
Signs of marijuana abuse
Fatigue
Lethargy
Somnolence
57
What's reaction formation
Coining extreme opposite
58
Autism spectrum disorder
Repetitive behavior + normal language
59
Absolute contraindication to electroconvulsive Rx
None
| Relative = recent cerebral hemorrhage, ICP
60
T/F: 2/3 of suicide death at 1st attempt
T
61
T/F: risk of suicide is higher in blacks
F: whites
62
Are SSRIs save in kids?
Yes 8-18 Yrs
63
SE of long term lithium
Nephrogenic DI
64
T/F: electroconvulsive therapy causes irreversible memory loss
F: reversible
65
Depression on SSRI => agitation , insomnia , sexual SE?
Rx with Mitrazpine = helps sleep , no agitation , rarely sexual. Helps appetite
NB: bupropion cause agitation!
66
Labs w/ lithium
Renal + thyroid
67
Akathisia
Motor restlessness
| SE of anti-psychotics
68
Rx of neuroleptic syndrome
D/C med
Dantrolene
+/- bromocriptine
+/- amantadine
69
MOA of resperidone + SE
Dopamine D2 receptor blocker
High prolactin
70
T/F: phenelzine interacts with st Johns wort and
T
| Levels become unpredictable
71
Anti depressant worsen HTN
Venlafaxine
72
Damage to parietal lobes (Rt + Lt)
Rt = contralateral hemi-neglect , dent deficit (anosagnosia)
Lt = Gerstmann's syndrome = Rt-Lt confusion, can't write, bad math
73
How to prevent benzo dependence
Use for short time
74
How are Atypical antipsychotics better than typical?
Cause less tardive dyskinesia
75
Sx suggestive of major depression
Withdrawal from family
76
```
T/F: anorexia nervosa causes:
Bradycardia
HTN
Parotid gland
Atropine breast
Dental caries
```
```
T
F
T
T
T
```
77
MC SE of TCA?
Dry mouth
78
What neurotransmitters decreased in depression
Serotonin
NE
Dopamine
79
Mature defense mechanisms
In healthy adults:
1. Altruism = service to others to experience empathy.
2. Anticipation = palming for future discomfort.
3. Asceticism = deny pleasure from experience.
4. Humor = express feelings in comic way
5. Suppression = postpone attention to impulse.
80
Neurotic defenses
1. Control = manage events to reduce inner conflicts.
2. Displacement = shift emotions
3. Externalizations = attribute personal matters to external world.
4. Inhibition = limit function to avoid anxiety.
5. Intellectualization = intellectual processing to avoid experiencing affect.
6. Isolation = separate Sth from associate affect.
7. Rationalization = rational explanation to justify action
8. Dissociation = modification of sense of self
9. Reaction formation = transforming unacceptable impulse into opposite
10. Repression = remove idea from conscious
11. Sexualize = bestowing sexual importance to objects
81
Immature defense
1. Acting out = impulsive action.
2. Block = block thought / impulse
3. Hypochondriasis = exaggerate illness to avoid situations.
4. Introjection = victim identity w/ aggressor
5. Passive-aggressive
6. Regression
7. Somatization = unconscious expression is psychotic pain in physical Sx.
82
Psychotic defense
Denial = replace reality w wishes.
Distortion = reshaping reality
Projection =
83
Is bupropion used in panic attacks? Why?
No.
| stimulating effect
84
Drugs contraindicated with lithium
Thiazides
ACEI
NSAIDs
85
Antipsychotic causes high glucose
Olanzapine
| Clozapine
86
What antipsychotic cause withdrawal if stopped abruptly?
Venlafaxine (?) short half life and rapid clearance if D/C
87
Mood stabilizers used in maniac episodes
Lithium
Valproic acid
Carbamazepine
88
Monotherpay induces mania in Bipolar
Fluoxetine
89
What's Tarasoff decision
Inform authorities when patient show intent towards a person
Keep patient in office till safe disposition is made
90
Neurotransmitter in OCD?
Serotonin
91
How to shift safely from MOAi to SSRI
Allow for 2 wk wash out period between stopping MOAi and starting SSRI
92
T/F: repeated episodes of alcohol withdrawal increase risk of future Sx?
T
93
Milieu therapy
Inpatient Rx
| Use hospital environment as therapeutic intervention.
94
SE of olanzapine
High TG
Agranulocytosis
Dry mouth (xerostomia)
Tardive dyskinesia
95
Panic disorder + BPH
No TCA
| Use SSRI
96
Addiction vs pseudo-addiction
Pseudo is how patients behave when pain is under treated and resolve completely when pain is effectively Rx.
97
What schizophrenic Sx respond well to anti psychotics
Positive Sx
Delusions
Hallucinations
Disorganized speech
98
T/F: antipsychotic don't cause urinary incontinence
T
99
MAOi contraindicated with what food
Aged cheese
Aged wine
High Tyramine
100
1st line in ADHD
Methylphenidate
Dextroamphetamine
Pemoline
101
Does ADHD cause intellectual disability
No
102
Psychotherapy for panic disorder
CBT
103
Cause of seasonal affective
Serotonin
104
Melatonin in seasonal affective
Worsens Sx
105
SE of methylphenidate in ADHD
```
HTN
Tachycardia
Insomnia
Headache
Anxiety
Growth suppression
```
106
MCC of delirium
Dementia
107
SE of antipsychotic + Rx
1. Parkinsonism
Tremor, Bradykinasia, micrographia
Rx: low dose, shift to atypical, anti-cholinergic
108
Anticonvulsant for mania
Valproic acid
Carbamazepine
109
When dose delirium termens start + how long last
Start 3-7 days after stopping
Last 7-10 days
110
% of alcoholic develop DT
Death from DT
5%
Death 35% if untreated + 5% of Rx
111
Pacing in Alzheimer's not Rx with anti cholinesterase
No additional Rx
112
Deal with paranoid patient
Explain diagnosis + Rx in details
Professional not too friendly
113
Piaget's Stage of cognition
1. Sensorimotor 0-2 Yrs
Explore via sensation + motor contact
Separation anxiety
```
2. Pre-operational 2-6
Symbols (words + images)
No logics
Pretend
Egocentric
```
3. Concrete operational 7-12
Logical about concrete objects
Add + subtract
Understand conversation
4. Formal operational >12
Reason abstractly
Hypothesize
114
What's schizophrenia drift
Schizophrenia patient move to cities + become urban poor
It's not urban poor that cause the disease it's where patients end up
115
What's biopsychosocial
Approach patient in biological psychological social manner
116
Drugs cause depression (15)
```
Isotretinoin
Alcohol
Disulfiram
Anticonvulsant: Metho + ethosuximide
Barbiturates: phenobarb + secobarb
Benzo:
BB: metoprolol, atenolol, carvedilol
Bromocriptine
CCB
Estrogen HRT
Fluoroquinolones
Interferon-alpha
Opioids
Statins
Acyclovir
```
117
Triad in Tourette's
Tourette's
OCD
ADHD
118
Tourette's population
Males (9x more )
119
Rx Tourette's
Alpha2-adrenergic = clonidine (less efficacy, less SE)
Dopamine antagonist: Haloperidol + pimozide (more effective, more SE)
120
Cardiac side effect of anti-psychotic
QT prolongation
| Torsades de pointes
121
Anti-psychotics cause hypertensive encephalopathy
TCA + MAOi
| Tyramine + MAOi
122
How to safely shift from one antipsychotic to another
Gradual reduction in dose of 1st drug then overlap with the 2nd drug before completely stopping the 1st one.
123
Rx of seasonal effective
early morning light therapy
124
T/F: Mania could be a Sx of MS
T
125
Is stammering ass with conversion disorder
No
126
Premenstrual dysphoric disorder Rx
Mood disorder
Fatigue
Insomnia
During luteal phase lead to missing work.
Rx: SSRI
127
Trazodone sexual SE
Priapism
128
Rx of bulimia
SSRI esp. fluoxetine
129
Tardive dyskinesia high risk population
Females
Older age
Hx or FHx of mood disorders or affective disorders.
Multiple antipsychotics
130
How to deal with borderline personality clinic setting
Maintain caring but detached stance.
Combine conflict resolution + social learning to minimize aggression
Be constantly available on phone
Frequent visits to monitor and provide support.
131
When explaining to borderline personality;
1. Detailed + technical
2. Simple + clear + non technical
Simple
132
Do you prescribe drugs for borderline? Why?
No
| Use it to self-harm themselves.
133
Drug contraindicated with MAOi (analgesics)
Meperidine
| Tramadol
134
Goal of Rx in anorexia nervosa
Prevent death from malnutrition
135
DOC in alcohol withdrawal
Short-acting benzo (liver impairment = short)
136
Smoking withdrawals
```
Impaired concentration
Longing for cigarette
Headache
Insomnia
Irritability
Inc. appetite
```
137
TCA poisoning
```
Sx in 2 hrs.
Palpitations + chest pain
Low BP
Altered LOC
Resp. depression => acidosis + low O2
```
138
Drugs cause mania
```
Definitive:
Levodopa
Steroids + anabolic steroids
MAOi
TCA
```
```
Risky:
Benzo
Amphetamine
Cimetidine
Captopril
Thyroxin
Methylphenidate
```
139
Psychiatric disease with T1DM?
Adjustment disorder + MDD
140
Rx of delirium in ICU
IV haloperidol increase dose q3min
141
Rx of social phobias
SSRIs
142
Anti depressant doesn't cause weight gain
Bupropion
143
Anti depressant cause weight gain
Mirtazapine > SSRIs (paroxetine > fluoxetine)
144
% of elderly with depression
20% in community
| 40% in nursing homes
145
T/F: TCA contraindicated in elderly
True cause postural hypotension + falls.
146
What's transvestism
Dressing and acting in manner of opposite sex
147
When does transvestism start?
Common in M or F?
Do they seek help?
Starts late childhood
M > F
Don't present for Rx
148
SE of amphetamine for ADHD
Transient insomnia + weight loss
149
Bipolar 1 vs 2
1: mania + depression
2: hypomania + depression
150
What's not considered conversion according to DSM 5
Sx limited to pain or sexual dysfunction
151
OCD risk in monozygotic twins?
Negligible
152
OCD more in M or F?
F (adults + kids)
153
Shortest half life benzo?
Alprazolam (xanax) 12 hrs.
154
Body dysmorphic asso
OCD
Social phobia
Delusional disorder
155
SSRI in elderly
Risk of falls
156
Activated charcoal helps in 90% of toxins except?
```
Iron
Lithium
Fluoride
Cyanide
Alkali
```
157
Sleep terror vs nightmare
Sleep terror = can't remember nightmares
Nightmare = remember
158
Anxiety vs OCD
Compulsions in OCD only.
159
MC neuro SE of SSRI
Insomnia > headache
160
What personality doesn't learn form experience + or feel guilt
Antisocial
161
Atypical depression Sx
Worst in morning and better at evening (diurnal variation in mood)
162
When is MAOi DOC?
Atypical depression
163
Rx of serotonin syndrome
Cyrproheptadine
164
Sleep abnormality in depression
Decreased REM latency
165
What's paraphilia? Example
Sexually arousing fantasies
Fetishism
Exhibitionism
Sexual sadism
Transvestism
166
T/F: Homosexuality is not paraphilia
T
167
MC endocrine SE of lithium
Hypothyroid > DI
168
Bupropion is contraindicated in?
Anorexia / bulimia
Seizures
Alcoholism
169
Hallucinations in narcolepsy
```
At sleep (hypnogogic)
On wakening (hypnopompic)
```
170
How to establish rapport?
Ask about feelings
171
How do disulfiram + Naltrexone work in alcoholism
Disulfiram = accumulates acetaldehyde
Naltrexone = decrease cravings
172
In bipolar when does mania recur if lithium stopped
6 mo
173
Most effective mono therapy in alcoholism
Chlordiazepoxide
174
Risk of schizophrenia in monozygotic
40%
175
Anti depressant avoid in anorexia nervosa
MAOi (phenelzine)
| dietary restrictions
176
T/F: lanugo hair in anorexia
T
177
Donepzil SE
Arrhythmia needs pacemaker
178
Rx of sducidal ideation
Hospital admission
179
What overdose is more fatal?
| Benzo or amitriptyline
TCA > benzo
180
T/F: opiates cause constricted pupils
True
| Opiates: heroine, hydrocodone, oxycodone, hydromorphone, oxymorphone
181
Atypical cocaine dependence
Mood swings
Snorting (inflamed nares : big turbinates)
Paranoia
182
Dr reminded of relative by a patient?
Countertransference
183
Patient sexually attracted to Dr
Transference
184
T/F: Depression in kids presents as antisocial behaviors
T
185
T/F: kids with depression will have schizophrenia as adults
F
186
Psychosis + Parkinson's Rx
Atypical antipsychotics: queitapine + clozapine
187
OBGYN SE of antipsychotics
```
Typical antipsychotic (risperidone)
Block dopamine = high prolactin = amenorrhea, infertility, galactorrhea
```
188
Criteria for somatic symptom disorder
```
Somatic Sx
Excessive thoughts ass. with the Sx
=> seriousness of Sx
=> anxiety about general health
=> time + energy to figure out Dx
```
189
Rx of narcolepsy
Methylphenidate
190
Childhood gender identity disorder starts at? How?
Age 2
Kids cross-dress + opposite gender games
Hate their genitals
191
Bupropion in panic disorder
Not effective
192
Drugs for methamphetamine dependence?
None affective
| Cognitive Rx only
193
School phobia vs truancy
Truancy: leave home but skip school
Phobia: Sx every morning disappear at weekends
194
Agitated with Hx of dystonia
Benzo vs haloperidol
Benzo
195
Benzo with shortest elimination half life
Triazolam
196
Flooding vs grader exposure Rx in phobia
Flooding: exposed and asked to reintegrate the subject, and remain there till anxiety resolve
Exposure: showing picture then going there
197
Capgras syndrome in psych
Patient thinks person replaced by exact double that acts exactly like original
198
Rx PTSD (psych)
SSRI
Benzo (acute)
Atypical antipsychotics (quetiapine, olanzapine, risperidone)
199
To diagnose adult ADHD
| When should Sx start?
Since childhood
200
Earliest SE of lithium
Tremors
201
Valproic acid vs carbamazepine in bipolar
Valproate for maniac episodes
Carbamazepine if multiple maniac episodes, mixed or rapid cycling
202
Which SSRI doesn't cause D/C syndrome
Fluoxetine
Bcz long 1/2 life of 4-6 days
203
ID, Ego, superego
ID:
Since birth
Unconscious = primitive + instinctive
Ego:
Based on reality
Satisfied ID in realistic ways
Superego:
Morals + standards
Acquired from parents, society and sense of right.
204
Drug not helpful in tardive dyskinesia
Haloperidol
205
Vitamin E in tardive dyskinesia
Short duration of benefit
206
Metabolic SE of valproate
High ammonia due to low carnitine
Dx. Replace carnitine
207
Insomnia in depression on SSRI
Trazdone or zolpidem
208
Delirium tremens in >65 Rx
Short acting benzo (lorazepam)
209
Cough / URTI drug causes serotonin syndrome if used with SSRIs
Dextromethoephan
210
Level of intellectual disability:
Symbolic communication
Understand gesture + emotions
Express non verbally
Profound
